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State officials seek to lower cost of Medicaid expansion

By GARRY RAYNOState House Bureau

CONCORD — State health officials want to help low-income residents stay on their private health insurance rather than go on Medicaid if the program is expanded under the Affordable Care Act.State Health and Human Services Department officials suggest expanding the current Health Insurance Premium Payment (HIPP) program as one way to lower the cost of expanding Medicaid eligibility to those at or below 138 percent of the federal poverty level.

Using the HIPP program would not require the state to seek federal approval for a program similar to Arkansas’ that provides coverage for eligible recipients through private insurers. Using HIPP would also reduce the state’s cost by $9.1 million over seven years and the federal government’s costs by $197 million.

“That is why we believe the HIPP option is so important to the overall conversion,” said Katie Dunn, state Medicaid director.

Agency officials explained the ACA Medicaid provisions and how they will affect the state, the medical and financial implications of expanding the program, and potential options to members of the Commission to Study Expansion of Medicaid Eligibility Tuesday.

Overall, health agency officials project expanding Medicaid will add 48,358 people to the program over the next 7½ years, while the federal government will pay $2.4 billion to health care providers. The state is expected to save $45.8 million over that period.

If the state decides to expand Medicaid eligibility, the federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent thereafter.

If the state expands eligibility to 138 percent or $15,856 for an individual and $27,916 for a family of four, the agency expects about 63,500 people to become eligible for the federal-state Medicaid health insurance program.

However, if the state expands its HIPP program, which pays the private health insurance premium for qualified individuals, about 13,774 individuals would be able to retain their private health insurance while Medicaid would pay the premium.

“A private insurance option is a way for us to look at ensuring that Medicaid is not the first payee, but rather the last payee,” said Jeff Meyers, Director of Intergovernmental Affairs for DHHS.

Currently, there are 175 individuals on the program, which would have to be significantly expanded to handle the influx of new recipients, said Dunn. She said the state would be likely to contract for those services.

“We would need to be proactive upfront to find out if they have third-party insurance coverage,” Dunn said, and be able to determine quickly if paying the premium would be the same cost or less than enrolling them in the Medicaid program.

Meyers said the state does not currently qualify for a demonstration grant, like Arkansas seeks, to use private insurers to cover Medicaid eligible adults because a state needs to have two qualified insurers offering programs in its health insurance exchange so recipients have a choice. Anthem Blue Cross is the only qualified carrier in New Hampshire to offer insurance coverage in the exchange that begins Jan. 1.

The department is also proposing changing the breast and cervical cancer program that serves about 500 people by phasing it out over the next four years or when those currently eligible finish their treatment.

Eligibility for the program is 250 percent of the federal poverty level and the change would move those above 138 percent of poverty into the health exchange to be covered by private insurance, while Medicaid would pay the premium.

The commission has until Oct. 15 to make recommendations on expansion.

The commission meets Tuesday to hear from the Insurance Department, and then Aug. 6, 13 and 27.grayno@unionleader.com